Myths and Facts About Sugar Substitutes

By Dr. Sanjay Gupta

Calorie-free sweeteners probably aren't dangerous, but they may not help you lose weight either.

Research suggests people are cutting back on their sugar intake, but it’s still having a serious health impact worldwide. According to the American Heart Association, tens of thousands of global deaths each year from heart disease, cancer, and type 2 diabetes may be linked to sugary drinks. For many people, artificial sweeteners offer a calorie-free way to satisfy sweet-tooth cravings. But do these sugar substitutes pose health risks, and how do they affect the way we taste and consume food?

“We still don’t fully understand the long-term effects of artificial sweeteners,” said Alexandra Kaplan Corwin, a registered dietician in the division of pediatric endocrinology and diabetes at The Children’s Hospital at Montefiore Medical Center in New York City. “Though the [U.S. Food and Drug Administration] has said they’re safe and the National Cancer Institute says they don’t cause cancer, we still don’t really know if there are long-term health consequences.”

In the 1970s, studies linked the sugar-substitute saccharine to urinary bladder cancer in lab rats. In response, Congress required that foods containing saccharine have a warning label. Follow-up studies found no cancer-risk in humans, and the National Institutes of Health removed saccharin from a list of suspected carcinogens in 2000.

The safety of another sugar substitute came into question after a study suggested an increase in brain tumors in the U.S. might be related to the use of aspartame. But the National Cancer Institute traced the increased tumor rates back to the 1970s, years before the substitute was on the market. Subsequent research found no connection between aspartame and cancer in humans. This month, the European Food Safety Authority concluded that aspartame is safe at levels contained in diet soda.

“None of these studies have been replicated in humans with the same results,” said Kristi King, a clinical dietician at Texas Children’s Hospital in Houston. “It seems like the amount of sweeteners you’d have to consume on a daily basis over your lifetime would have to be enormous to have any kind of detrimental side effect.”

While there’s no evidence these sugar substitutes are dangerous, a recent study suggests they don’t guarantee weight loss. Researchers from the Yale University School of Medicine found that eating foods with artificial sweeteners when we’re hungry or tired increases the likelihood of choosing higher-calorie foods later on.

Brain scans of mice found that the brain signal that regulates levels of dopamine, a neurotransmitter associated with the brain’s reward center, is only triggered when regular sugar is broken down. “The results suggest that a ‘happy medium’ could be a solution; combining sweeteners with minimal amounts of sugar so that energy metabolism doesn't drop, while caloric intake is kept to a minimum,” according to Yale professor and study lead Ivan de Araujo.

“Artificial sweeteners aren’t necessarily a magic bullet for weight loss,” said Corwin. “They don’t contain calories, but you have to make sure you’re not letting yourself think you can eat more because you had a diet soda instead of a regular one.”

Sugar substitutes are much sweeter than sugar, which can have an adverse effect on how we choose what foods to eat. “If you’re having a lot of artificial sweeteners, they can increase your preference for them and make more nutritious foods less tasty and appealing,” said Corwin.

Here’s how five FDA-approved artificial sweeteners measure up on the “sweetness scale,” according to the Sugar Association:

Acesulfame K, or ace K, is 200 times sweeter than sugar.

Aspartame (marketed as Equal and NutraSweet) is 200 times sweeter than sugar.

Neotame is about 40 times sweeter than aspartame, or 8,000 times sweeter than sugar.

Saccharine (commonly sold as Sweet ’N Low) can be between 200 and 700 times sweeter than sugar.

Sucralose (sold as Splenda) is 600 times sweeter than sugar.

For people trying to lose weight or manage conditions like heart disease and diabetes, the American Heart Association and the American Diabetes Association support the moderate use of artificial sweeteners. Reducing sugar in your diet is important, but “sugar free” isn’t the same as healthy.

Here are some healthy tips on consuming sugar and sugar substitutes:

If you’re looking to avoid both sugary and artificially sweetened drinks, try water or seltzer flavored with fruit slices or mint leaves.

Among sugar substitutes, Corwin prefers the natural sweetener stevia, which is derived from a plant. Refined stevia extract is “generally regarded as safe,” but the FDA hasn’t approved it in whole-leaf or crude form because of concerns about possible side effects.

When buying juice drinks for your kids, look for the phrase “100 percent juice.” Those juices will contain the vitamins and minerals found in the fruit, said King. Avoid products that are “fruit flavored.”

The AHA recommends fresh fruit or canned fruits packed in water or natural juice over fruit canned in syrup. Instead of adding sugar to oatmeal or cereal, use fresh or dried fruit.

Avoid nutrient-poor, processed foods and beverages with added sugar, said King. Naturally occurring sugars found in fruit and milk, in moderation, can still be part of a healthy diet.

Last Updated: 12/17/2013

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